Only one case in childhood has been previously reported,1 and this was the case of a 12yr. When a ureterocele involves the upper pole of duplex ureters, treatment depends on function in that renal segment, because of the significant incidence of renal dysplasia. The term retrocaval ureter is used interchangeably with circumcaval or postcaval ureter, which describes the anatomic relationship of the ureter to the embryologically abnormal inferior vena cava. Abstract two cases of retrocaval ureter are reported that were successfully treated by a laparoscopic approach. The prevalence of this condition is approximately 1 per 1,000 persons, with males 23 times more likely than females to develop the condition. Surgery that involves resection of the retrocaval segment and relocation of the anastomosis anterior to the inferior vena. The incidence of circumcaval ureter develops predominantly on the right side, but when it is reported on the left side, this congenital anomaly is associated with either partial or complete situs inversus or duplication of the inferior vena cava ivc 1 x 1 watanabe, m. Diagnosing ureteral stricture in adults nyu langone health. Role of ureteroscoy and retrograde studies of the ureter in. A threeport ral system was used to dissect free the obstructed ureter. Get a printable copy pdf file of the complete article 2.
Discussion retrocaval ureter is a rare congenital anomaly that is caused. Retroperitoneoscopic ureteroureterostomy for retrocaval ureter. Retrocaval ureter also referred to as preureteral vena cava is a rare congenital anomaly with the ureter passing posterior to the inferior vena cava. Ureteral anomalies should be suspected in children with an episode of pyelonephritis or recurrent urinary tract infections. Renal calculi are also present, presumably due to stasis. The ureter classically course medially behind the inferior vena cava winding around it and then passes laterally in front of it to then course distally to the bladder. Campbell 5 stated in his 1963 textbook that about 90 cases had been reported to date, and the diagnosis was made preoperatively in 28. The upper part of the ureter closest to the kidney is supplied by the renal arteries.
Retrocaval ureter is a rare congenital anomaly occurring with incidence of about 1 in 1500 people with a three to four times male predominance in autopsy studies. Since the original report of retrocaval ureter in 1893, 44 cases have been reported in the literature. Retrocaval ureter is still a rare congenital anomaly. Pain on percussion of the right lumbar region was evident on physical examination. Laparoscopic ureteroureterostomy for retrocaval ureter. Retrocaval ureter has been previously diagnosed by ivu and rgp, but nowadays, ct scan is the best modality for diagnosis 5. We present a case of a 49yearold male who presented with loin pain and upon. Robotic ureteroureterostomy of the retrocaval ureter. Left retrocaval ureter associated with inferior vena caval duplication. Retrocaval ureter is an uncommon clinical entity that generally causes upper urinary tract obstruction on the right side as the right ureter courses posterior to the inferior vena cava.
Dogan hs, oktay b, vuruskan h, yavascaoglu i 2010 treatment of retrocaval ureter by pure laparoscopic pyelopyelostomy. Though it is a congenital anomaly, patients do not normally present with symptoms until the 3rd and 4th decades of life from a resulting hydronephrosis. Ct scan below the level of the kidneys demonstrates a more medial retrocaval placement of the right ureter. However, we believe mri is likely to replace ct in the diagnosis of retrocaval. Retrocaval ureter is a congenital abnormality resulting from persistence of the subcardinal vein and gives rise to various degrees of obstructive uropathy. Retrocaval ureter medigoo health medical tests and. Removal of the affected renal segment and ureter may be preferable to obstruction repair if no segmental renal function is found or if significant renal dysplasia is suspected. Unilateral ectopic ureter is seen with equal frequency on right and left sides, and involvement is bilateral in 25% of cases. The right ureter was divided at the lateral border of the ivc and distal part dissected free from the ivc. Variations in the reported laparoscopic techniques include transperitoneal laparoscopic repair, retroperitoneal laparoscopic repair and. All of the patients had type 2 and rightsided retrocaval ureter. The condition becomes symptomatic usually by the third decade of life.
Ct scan demonstrates rightsided hydronephrosis and hydroureter because the right ureter passes behind the inferior vena cava at the level of lower endplate of l3 vertebra. A retrocaval ureter, which is also called circumcaval ureter, is an abnorm development of vena cava and ureter. In man the two ureters are tubular organs through which urine flows from the kidneys into the urinary bladder. A rare case of right retrocaval ureter with duplication of. Circumcaval ureter, also known as retrocaval ureter, is a term used to describe an abnormal course of a ureter that encircles the inferior vena cava. Duplication of ivc is another rare congenital anomaly in the development of ivc. To debate the different laparoscopic approaches for the surgical management of patients with circumcaval ureter. Retrocaval ureter definition of retrocaval ureter by. Many journals and textbooks deal with the physiology, pathology, diagnosis, and therapy of derangements of the urinary tract. So far ct has been the procedure of choice to confirm the diagnosis of retrocaval ureter.
The designation preureteric vena cava more accurately. A 60yearold man presented with a 30year history of back pain which had worsened over 3 days. A case diagnosed preoperatively and treated successfully by a plastic operation. The ureters are tubes made of smooth muscle fibers that propel urine from the kidneys to the urinary bladder. Ct scan of the abdomen revealed hydronephrosis and dilatation of the right proximal ureter upto the level of l4. In urography, the medial deviation of the right ureter in the rare circumstance in which it passes behind the inferior vena cava before entering the pelvis.
Circumcaval ureterretrocaval ureter bmj case reports. From the basic science underpinnings to the most recent developments in medical and surgical care, campbellwalshwein urology offers a depth and breadth of coverage you wont find in any other urology reference. Radiation oncologyureter wikibooks, open books for an open. Case 1 was a 20yearold woman who presented with symptoms of a right ureter stone. We prefer the designation circumcaval ureter, since it best describes the anomaly and since one of us w. The major radiographic features are the marked medial deviation of the ureter. Association of retrocaval ureter with a stone in the looping segment of the ureter is extremely rare. Gladstones case, that of an acardiac monster, is the only example on record to date.
So if you are looking to learn the latest surgical procedures or share your latest surgical knowledge, feel free to browse. Each patient was evaluated using gray scale ultrasound and color. Limits of dissectio rt n ureter leftsided modified template primary rplnd left ureter, left renal vein, left edge of vena cava, ima, ipsilateral iliac artery, where the ureter crosses. Retrocaval ureter is abnormal looping of the proximal ureter behind the inferior vena cava. Persistence of both ventral and dorsal limbs will result in the ureter passing between the cavae.
Retrocaval ureter a rare cause of hydronephrosis in. Lap retrocaval ureter 12 30 min surgery video urology video. The ureter is slightly dilated proximal to this point and returns to a normal position distal to its retrocaval placement. Laparoscopy seems safe, feasible, and reproducible in managing retrocaval ureter. Laparoscopic repair of retrocaval ureter meddy bear. The result is that a ureter is displaced so that, in its course to the urinary bladder, it encircles the vena cava. Retrocaval ureter presenting at 6 years of age in a girl. The aberrant anatomy results in the compression of the ureter causing hydronephrosis. Four types of retrocaval ureter have been observed in man. Retrocaval ureter also referred to as circumcaval ureter or preureteral vena cava is a rare congenital anomaly with the ureters passing posterior. This narrowing causes an obstruction in the flow of urine. Congenital malformations of the ureter and kidney questions.
Retrocaval ureter is a rare entity 1 with a reported incidence of approximately 1 in 1100 and a 2. Its etiology is assumed to be abnormal embryologic development of the inferior vena cava as a result of atrophy failure of the right subcardinal vein in the lumbar portion. The ureters are tubes leading from the kidneys to the bladder. It may become the procedure of choice along with laparoscopic surgery for retrocaval ureter. Complete laboratory evaluation including urinalysis, complete blood picture, urea, creatinine and electrolytes. Kansas 1992 pmid 1429099 adjuvant radiotherapy in high stage transitional cell carcinoma of the renal pelvis and ureter. Extrinsic obstruction of the ureter is caused when organs press against the ureter, causing a blockage in the ureter. Rajeevan 1 1 department of urology, government medical college, calicut, kerala, india abstract article info. This paper deals with an interesting anomaly of the inferior vena cava which has been variously called postcaval ureter, retrocaval ureter, circumcaval ureter, and preureteric vena cava. Robotic retrocaval ureter repair without excision of the retrocaval segment is feasible and an effective alternative to open or laparoscopic retrocaval ureter repair with good anatomical and functional outcome. Here, ureter passes between the inferior vena cava ivc and psoas muscle and gets compressed. Five months postoperatively the patient, symptom free, was readmitted to the hospital for evaluation. A spatulated watertight ureteroureterostomy was then fashioned after transposition of the ureter.
The images showed that the upper part of the right ureter was dilated and the portion lying. A 14 year old male presented with a three months history of right flank pain that was of sudden onset and initially colicky but had become constant. Usually ureterogram in conjunction with venacavogram can establish diagnosis. Ureteral anomalies urinary system veterinary manual. A lowgrade vaginitis or vulvitis may also be present due to urine scalding. The images showed that the upper part of the right ureter was dilated and the portion. She had no history of fever, dysuria, haematuria or weight loss. The findings on iv urography are correlated with the mri findings. Both of these terms are somewhat misleading, as this configuration is considered a developmental anomaly of the inferior vena cava ivc.
Retrocaval location of the ureter is a rare ontogenic vessel anomaly. In 1893, hochstetter first described retrocaval ureter. If the most dependent portion of the renal pelvis marked with the silk stitch does not easily meet the spatulated ureteral end, the following maneuvers should be considered. Introduction retrocaval ureter is a rare congenital anomaly reported the rst time by hochstetter in. Role of ureteroscoy and retrograde studies of the ureter in diagnosis and treatment of ureteric pathology. Retrocaval ureter is a rare congenital anomaly, with the ureter passing posterior to the inferior vena cava. Learn vocabulary, terms, and more with flashcards, games, and other study tools.
Jan 14, 2020 ureteral disorders occur when ureters become blocked or injured, which affect the flow of urine to the bladder. Retrocaval ureter also referred to as circumcaval ureter or preureteral vena cava is a rare congenital anomaly with the ureters passing posterior to the inferior vena cava. If a stone leaves the kidney and gets stuck in the ureter, it is called a ureteral stone. Mullen and engel state that 55 cases have been reported. Ureters article about ureters by the free dictionary. Diagnosis 256 double urethra and accessory urethra 257 incomplete dorsal accessory urethrablind 258 incomplete dorsal accessory urethracommunicating with the urethra 259 etiology and pathology 261 clinical presentation 268 diagnosis 270 treatment. Left preureteral vena cava retrocaval or circumcaval ureter associated with partial. The ureter was found to be coursing medially posterior to the ivc, at this level with normal caliber distal to it. View enhanced pdf access article on wiley online library html view download pdf for offline viewing.
Full text full text is available as a scanned copy of the original print version. On the average, each ureter is 3035 cm long and 79 mm at its widest diameter. Diagnosis and laparoscopic management of retrocaval ureter. The middle part of the ureter is supplied by the common iliac arteries, direct branches from the abdominal aorta, and gonadal arteries the testicular artery in men or ovarian artery in women. This volume, focusing on the ureter and the diseases which involve it, is an updated second edition.
Treatment and prognosis if treatment is required, surgical relocation of the ureter anterior to the ivc can be performed. It is about 10 inches long, with the upper half in the belly and the lower half in the pelvic area. Laparoscopic transperitoneal repair of retrocaval ureter. Adequate dissection and mobilization of the ureter and periureteral tissue is mandatory to ensure a tension free anastomosis while preserving its blood supply. A 33yearold nondiabetic married woman from rural background presented with complaints of dull intermittent right flank pain since 1 year. The axial ct below shows the inferior ureter white arrow coursing posterior to the inferior vena cava red arrow. Retrocaval ureter with stone in the retrocaval segment of. We present a case of retrocaval ureter and its mr appearances. Ivp and ct demonstrate partial obstruction of the right renal collecting system with a retrocaval ureter.
Associated anomalies were seen in none of the patients. Management of ureteral calculi canadian urological association. A retrocaval ureter circumcaval ureter is a developmental anamoly of inferior vena cava ivc. Three asymptomatic patients were diagnosed by routine physical examination. Clinical examination of the abdomen was within normal limits. Retrocaval ureter a rare cause of hydronephrosis in children. The diagnosis was made roentgenographically on the basis of the sshaped course of. Start studying congenital malformations of the ureter and kidney. Show full abstract of right retrocaval ureter was confirmed and the patient was treated by dissection and ureteroureteral anastomosis. Retrocaval ureter is a rare anomaly in the paediatric age group. Ureteral anomalies pediatrics msd manual professional edition. This is a very infrequent cause of hydronephrosis in children. Right retrocaval ureter and left nutcracker syndrome. The first case of a simultaneous retrocaval ureter and retroperitoneal fibrosis of the right ureter is presented.
Retrocaval ureter, also known as circumcaval ureter, is a rare congenital anomaly which commonly presents with loin pain in middle age group. Retrocaval ureter is a rare entity1 with a reported incidence of approximately 1 in 1100 and a 2. Effects in the rabbit were limited to the fetus where the 30 mgkg tgf1 mab dose produced a slight decrease in fetal weight and an increase in the incidence of retrocaval ureter and an absent andor malpositioned kidney ureter in. The ureter is a muscular tube that transfers urine from the kidney to the bladder. Unfortunately both term suggest that ureter is at fault whereas in reality it is the ivc. All patients were symptom free ae r surgery and had reduction of hydronephrosis in control imagery. Ureteral disorders ureters ureter function medlineplus. Though congenital,it commonly manifests in the third to fourth decade of life and very rarely in children. Retrocaval ureter is a rare condition which leads to obstruction of the right kidney. Due to the persistence of the right subcardinal vein in the lumbar area, the vena cava develops ventral of the right ureter zhang et al, 1990. Nyu langone urologists are experts in diagnosing ureteral stricture, which is a narrowing of one of the ureterstubes that carry urine from each kidney to the bladder. Type i low loop is the most common, with the dilated proximal ureter assuming the shape of a reverse j.
The term hydroureter will be used in this chapter for all forms of chronic dilatation, including those for which a urethral obstruction is clearly responsible, while megaureter is reserved for the clinical group in which no organic obstruction can be found, and in which ureteric activity appears to follow a characteristic pattern. Retrocaval ureter description, causes and risk factors. In the present paper the authors report on four cases, discussing their diagnostic, clinical and therapeutic aspects. Our single center experience serdar aykan 1, ahmet urkmez 1, musab ali kutluhan 2, mustafa zafer temiz 3, atilla semercioz 3, ahmet yaser muslumanoglu 3 1 department of urology, haydarpasa numune research and training hospital, istanbul, turkey. The ureter, instead of passing lateral to the vena cava, passes behind it, partially encircles it for a short distance, and then pursues its normal course ventral to the vena cava, downward into the bony pelvis and thence to the bladder. Excision of the retrocaval segment with end to end ureteral anastomosis over a stent was done figure 3. Involved ureters may open into the urethra, the uterus, or the vagina. Boston scientific provides an extensive offering of ureteral stents featuring the percuflex material with hydroplus coating, varied coil configurations and. Twentytwo of these cases were diagnosed post mortem, and eight cases were diagnosed preoperatively. Retrocaval ureter is a congenital anomaly which arises during the embryonal period when the cardinal and subcardinal veins consolidate to form the vena cava. When this occurs, urine backs up into the kidney and may cause pain, urinary tract infections, or kidney damage. Mar 20, 2010 a 60yearold man presented with a 30year history of back pain which had worsened over 3 days.
Abstract ureteroscopy is defined as upper urinary tract endoscopy performed most commonly with an endoscope passed through the urethra, bladder, and then directly into the upper urinary tract. A transperitoneal approach was used for case 1, and a retroperitoneal approach was used. Murphy, md, javier casillas, md, and josluis becerra, md the computed tomography and sonography appearance of retrocaval ureter is correlated with findings on intravenous urography. British association of urological surgeons standards for. A preureteric vena cava, also known as a retrocaval ureter, is a rare congenital malformation of the right human ureter, in which the ureter passes behind the inferior vena cava, causing compression possibly leading to hydronephrosis. Learningradiology retrocaval ureter, circumcaval ureter. The ureter exits medially between the cava and the aorta to return to its normal position. The ureter is medial to the pedicle of the vertebral body blue arrow. Circumcaval ureter is a rare congenital anomaly with the ureter passing posterior to ivc, usually associated with hydronephrosis, results from anomalous development of the ivc and requires surgery in symptomatic cases. We report a rare case of right retrocaval ureter and left nutcracker syndrome in a young man who was accurately diagnosis preoperatively with the help of intravenous urogram and grayscale and color flow doppler ultrasonography, and confirmed by computed tomography. Full blood count, urinalysis and blood urea and creatinine were normal. Retrocaval ureter and contra lateral renal agenesis a.
Crushing of the ureter iatrogenically during surgery by grasping or ligation e. Testing typically involves ultrasonography of the kidneys, ureters, and bladder before and after voiding, and then fluoroscopic voiding cystourethrography. Urinalysis was negative for red blood cells, white blood cells, or protein. Retrocaval ureter can be associated with turners syndrome. A study of cases article pdf available in urology journal 33. An ectopic ureter forms when the origin of the ureteral bud from the mesonephric duct is abnormally high, and separation of the bud from the duct is delayed or does not occur.
Retrocaval ureter medigoo health medical tests and free. Retrocaval circumcaval ureter associated with solitary. Sonographic detection of renal and ureteral stones. The ureter has an arterial supply which varies along its course.
1322 1558 1492 520 1516 301 1415 28 1306 1493 792 542 1017 1311 868 922 608 184 1209 706 147 510 10 506 1479 1057 969 818 290 506 1462 834 1402